Association between reduced cervical extensor muscle mass and postoperative outcomes after single-door laminoplasty in elderly patients with cervical spondylotic myelopathy: a retrospective study

BACKGROUND: To investigate the association between preoperative cervical extensor muscle fatty infiltration and postoperative clinical and radiographic outcomes after posterior open-door laminoplasty in elderly patients with cervical spondylotic myelopathy (CSM). METHODS: Elderly patients (>60 years) who underwent first-time posterior single-door laminoplasty for multilevel CSM between January 2015 and December 2020 were retrospectively reviewed. All patients had a minimum follow-up of 12 months. Fatty infiltration of cervical extensor muscles was assessed on preoperative MRI using the Goutallier grading system and classified as mild, moderate, or severe. Clinical outcomes (Japanese Orthopaedic Association JOA score, Neck Disability Index NDI, Visual Analog Scale VAS), minimal clinically important difference (MCID), perioperative parameters, and cervical sagittal alignment were evaluated. RESULTS: < 0.001). CONCLUSION: Severe fatty infiltration of cervical extensor muscles is associated with poorer neurological recovery, prolonged hospitalization, and sagittal imbalance after laminoplasty in elderly CSM patients. Preoperative MRI-based muscle quality assessment may improve risk stratification and guide surgical planning and postoperative rehabilitation.